Elsevier

Ophthalmology

Volume 110, Issue 12, December 2003, Pages 2292-2301
Ophthalmology

Psychometric properties of the National Eye Institute–Refractive Error Quality of Life instrument

https://doi.org/10.1016/j.ophtha.2002.07.001Get rights and content

Abstract

Objective

To estimate the psychometric properties of a vision-targeted measure of health-related quality of life, the National Eye Institute–Refractive Error Quality of Life survey (NEI-RQL), which includes 13 scales designed to assess the impact of refractive error and its correction on day-to-day life.

Design

Cross-sectional survey.

Participants

The NEI-RQL was self-administered by 667 myopes, 380 hyperopes, and 114 emmetropes recruited from the practices of 6 medical centers. All participants had near and distance visual acuity of 20/32 or better in the worse eye while benefiting from their current method for correction of refractive error (glasses, contact lens, refractive surgery).

Methods

Mean scores, standard deviations, internal consistency reliability, and test–retest intraclass correlations were estimated for the NEI-RQL scales. Item discrimination was assessed by item–scale correlations. Construct validity was evaluated by assessing the sensitivity of scale scores to type of refractive error, type of refractive error correction, and spherical equivalent. Construct validity of the NEI-RQL was compared to those of the Medical Outcomes Study 36-item short-form health survey (SF-36) and the National Eye Institute Vision Functioning Questionnaire (NEI VFQ-25) in a random subsample of respondents.

Main outcome measures

The 13 NEI-RQL scales—clarity of vision, expectations, near vision, far vision, diurnal fluctuations, activity limitations, glare, symptoms, dependence on correction, worry, suboptimal correction, appearance, and satisfaction with correction.

Results

Emmetropes tended to score significantly better on the NEI-RQL scales than myopes and hyperopes. The method of refractive error correction was also associated with NEI-RQL scores. In addition, the NEI-RQL multi-item scales accounted for 29% of the variance in the NEI-RQL satisfaction with correction item beyond that explained by the SF-36 and the NEI VFQ-25.

Conclusion

These results support the reliability and construct validity of the NEI-RQL. The instrument appears to be useful for comparisons of people with different types of correction for refractive error.

Section snippets

Subject recruitment and eligibility

Subjects for this study were recruited between June 1999 and October 2000 from advertisements and the ophthalmology practices of 6 medical centers (University of Alabama at Birmingham; University of California, San Francisco; Henry Ford Health System, Detroit; The University of Texas Southwestern Medical Center at Dallas; Naval Medical Center, San Diego; and Case Western Reserve University, Cleveland) using clinical records and advertisements. All appropriate institutional review boards

Sample characteristics

Of the 1161 persons who agreed to be evaluated for eligibility and were eligible (226 from University of Alabama at Birmingham, 203 from University of California, San Francisco; 226 from Henry Ford Health System, Detroit, 262 from University of Texas Southwestern Medical Center, Dallas; 21 from Naval Medical Center, San Diego; and 223 from Case Western Reserve University, Cleveland), 7 refused to participate.

The 1154 study participants included 114 emmetropes, 375 hyperopes, and 665 myopes. The

Discussion

There are multiple criteria by which the success of correcting refractive error can be indexed. The most commonly cited metric in the clinical literature is Snellen visual acuity. In addition, the magnitude of residual refractive error is used as a measure of efficacy and precision of the correction technique. The use of this information alone, however, fails to distinguish accurately those patients with successful outcomes from those who have limitations in day-to-day functioning and

Acknowledgements

The authors thank the members of the NEI-RQL Technical Advisory Group (Richard L. Abbott, MD, University of California, San Francisco; Anthony J. Adams, OD, PhD, University of California, Berkeley; Anita Stewart, PhD, University of California, San Francisco; Robert D. Sperduto, MD, NEI; A. Ralph Rosenthal, MD, Food and Drug Administration; Sally Shumaker, PhD, Bowman Gray) for their helpful input during several meetings. They also thank Paul Lee, MD, for providing valuable consulting advice,

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    The National Eye Institute was responsible for Technical Advisory Committee appointment and funded 90% of the project under a support contract (no. NO1-EY-6-2112) to The EMMES Corporation. Additional funding came from the American Academy of Ophthalmology, Allergan, Inc., Bausch & Lomb, Inc., and others in industry. Dr Hays was supported in part by the UCLA/DREW Project EXPORT, National Institutes of Health, National Center on Minority Health & Health Disparities (P20-MD00148-01). Drs Hays and Mangione were also supported in part by the UCLA Center for Health Improvement in Minority Elders/Resource Centers for Minority Aging Research, National Institutes of Health, National Institute of Aging (AG-02-004).

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